Healthcare Provider Details

I. General information

NPI: 1891724720
Provider Name (Legal Business Name): PROFITNESS PHYSICAL THERAPY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2006
Last Update Date: 12/16/2023
Certification Date: 12/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

171 E 84TH ST 2ND FLOOR
NEW YORK NY
10028-2000
US

IV. Provider business mailing address

171 E 84TH ST 2ND FLOOR
NEW YORK NY
10028-2000
US

V. Phone/Fax

Practice location:
  • Phone: 212-327-0600
  • Fax: 212-327-0776
Mailing address:
  • Phone: 212-327-0600
  • Fax: 212-327-0776

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: SCOTT MITCHELL BEDSON
Title or Position: VICE-PRESIDENT
Credential: PT
Phone: 212-327-0600